急诊超声在消化道出血合并腹主动脉夹层诊断中的价值

目的探讨消化道出血时急诊超声预示腹主动脉夹层的重要性。方法对2757例急性消化道出血患者行急诊超声检查腹主动脉及其主要分支,对超声发现腹主动脉内中膜增厚或斑块,以及腹主动脉走行扭曲、腹主动脉扩张或腹主动脉夹层等异常者行腹主动脉CTA,将超声与CTA诊断腹主动脉夹层的结果进行对照分析。结果 2575例急性消化道出血患者中,超声提示腹主动脉异常46例,其中腹主动脉夹层10例,腹主动脉斑块26例,腹主动脉扩张7例,腹主动脉扭曲3例。经CTA证实腹主动脉夹层12例,超声准确诊断10例,漏诊2例,其中1例超声表现类似低回声斑块,另1例仅见腹主动脉扩张;其余均与CTA结果一致。所有腹主动脉夹层患者的腹腔干或肠系膜上动脉均开口于假腔。结论急诊超声可及时诊断以消化道出血为主要临床表现的腹主动脉夹层或提供诊断线索;消化道出血时急诊超声须警惕腹主动脉夹层,应仔细扫查腹主动脉及其主要分支,避免漏诊该病造成严重后果。     

彩超诊断肠系膜上动脉病变的价值

目的探讨彩超诊断肠系膜上动脉(superior mesenteric artery,SMA)病变的价值。方法因腹痛就诊拟诊SMA病变患者104例,均行彩超检查,观察SMA管腔有无斑块、血栓、动脉瘤等,有无狭窄或闭塞,并测量狭窄处及腹主动脉血流速度;对超声诊断SMA病变者行CT血管造影(CT angiography,CTA)检查,并进行结果对比。结果超声检查共检出SMA病变17例,其中粥样硬化斑块并重度狭窄11例,闭塞2例(1例为完全闭塞,1例为起始段闭塞并侧支循环形成),主动脉夹层累及SMA致血栓形成2例,SMA动脉瘤2例,均经CTA证实超声诊断。结论彩超对SMA病变诊断价值较高,并与CTA具有良好一致性。     

彩色多普勒超声诊断腹主动脉夹层动脉瘤

目的　应用彩色多普勒超声诊断腹主动脉夹层动脉瘤。方法　应用彩超测量腹主动脉内径 ,观察腹主动脉及其分支内膜分离的部位和范围 ,以及鉴别真假腔。结果　内膜分离是本病最可靠的诊断依据 ,血流分隔现象、动脉扩张和管腔内血栓等具有重要的辅助诊断价值。彩超能很好地鉴别真假腔和诊断夹层动脉瘤破裂。结论　彩超能正确地评价本病受累血管 ,是诊断腹主动脉夹层动脉瘤的一种较为可靠的影像检查方法。     

双源CT主动脉成像在DeBakey I型主动脉夹层杂交手术前后评价中的价值

目的：评价双源CTA在DeBakey I型主动脉夹层杂交手术治疗前后的应用价值。方法：回顾性分析11例夹层破口位于升主动脉或主动脉弓的DeBakey I型胸主动脉夹层患者行杂交手术术前及术后CTA,6例患者的术中DSA资料和CTA进行对照分析。结果：11例患者术前CTA明确诊断为DeBakey I型主动脉夹层,6例破口位于升主动脉根部上方附近,3例位于主动脉弓部,2例假腔机化,11例均累及胸主动脉及降主动脉,4例累及主动脉弓主要分支;术后CTA复查均很好显示置入支架位置,假腔血栓机化情况,重建主动脉弓及旁路血管显示清晰,其中2例患者左侧锁骨下动脉起始段闭塞,1例主动脉弓部局部出现内漏,其余患者夹层假腔内血栓机化,真腔内径扩大,旁路血管通畅。结论：双源CT主动脉成像在DeBakey I型胸主动脉夹层杂交手术前后的评价中有非常重要的价值。     

超声诊断主动脉夹层1例

患者老年女性,因"腹痛3小时"就诊。临床初步诊断:腹痛待查,阑尾炎?腹部全面超声扫查示:右下腹部未见明确肿大阑尾图像,腹主动脉扩张,管壁粗糙,管腔内可见隔膜样回声,腔内血流紊乱。经胸超声心动图检查示:升主动脉增宽。超声诊断:主动脉异常所见,考虑主动脉夹层。患者遂行主动脉CTA检查示:主动脉夹层(图3)。患者收入心外科进一步治疗。本病例超声诊断结合相关文献,心脏大血管全面超声检查不仅可以发现主动脉夹层的异常线索,还可以观察病变累及范围,为临床治疗提供依据,避免误诊和漏诊。     

彩色多普勒血流成像与磁共振血管造影在腹主动脉夹层诊断中的对比研究

目的通过对比腹主动脉夹层患者彩色多普勒血流成像(CDFI)与磁共振血管造影(MRA)影像学特征,探讨彩色多普勒超声在腹主动脉夹层诊断中的作用.方法回顾性分析29例腹主动脉夹层患者CDFI与MRA影像学特征,分析CDFI和MRA在识别撕脱内膜、内膜破口位置、真假腔、假腔血栓、夹层累及范围和腹主动脉分支起源上的一致性.结果内膜撕脱和真假腔的存在在CDFI和MRA间有较好的一致性(Pa=0.857和Pa=0.793),对破口的检出是一致的(Pa=1.000);两者在夹层累及范围、腹主动脉分支起源及管腔内是否血栓形成上同样显示了较好的一致性(Pa＞0.6).结论CDFI在腹主动脉夹层诊断中,各项指标与MRA结果显示良好的一致性,且又有方便、快捷、安全、价廉等优点,对腹主动脉夹层的急诊诊断、治疗方法的选择、随访均有重要的临床价值,因此认为CDFI可作为诊断腹主动脉夹层的重要影像学依据及常规检查方法.     

《临床肿瘤病案超声影像图解》多媒体光盘出版发行

目的通过对比腹主动脉夹层患者彩色多普勒血流成像(CDFI)与磁共振血管造影(MRA)影像学特征,探讨彩色多普勒超声在腹主动脉夹层诊断中的作用.方法回顾性分析29例腹主动脉夹层患者CDFI与MRA影像学特征,分析CDFI和MRA在识别撕脱内膜、内膜破口位置、真假腔、假腔血栓、夹层累及范围和腹主动脉分支起源上的一致性.结果内膜撕脱和真假腔的存在在CDFI和MRA间有较好的一致性(Pa=0.857和Pa=0.793),对破口的检出是一致的(Pa=1.000);两者在夹层累及范围、腹主动脉分支起源及管腔内是否血栓形成上同样显示了较好的一致性(Pa＞0.6).结论CDFI在腹主动脉夹层诊断中,各项指标与MRA结果显示良好的一致性,且又有方便、快捷、安全、价廉等优点,对腹主动脉夹层的急诊诊断、治疗方法的选择、随访均有重要的临床价值,因此认为CDFI可作为诊断腹主动脉夹层的重要影像学依据及常规检查方法.     

妊娠合并急性主动脉夹层一例并文献复习

目的探讨妊娠合并急性主动脉夹层的早期诊断与治疗方法。方法报道妊娠合并Stanford B型主动脉夹层1例,并收集近年文献进行复习,总结该疾病的临床表现、诊断及治疗方法。结果收集近年来8篇妊娠合并急性主动脉夹层的文献,共9例,所有患者均通过临床表现及经胸超声心动图(TTE)、经食管超声心动图(TEE)、CT血管造影(CTA)等检查手段而确诊。其中8例为Stanford A型,1例为B型。8例A型患者均行剖宫产+急诊手术治疗,出现1例患者死亡,1例胎儿死亡;1例B型患者行药物保守治疗,患者存活,胎儿流产。本文报道病例为妊娠合并Stanford B型主动脉夹层,早期行药物保守治疗,于妊娠37周胎儿发育成熟时行剖宫产术,而后择期行主动脉夹层腔内隔绝术,患者及胎儿均存活。结论妊娠合并急性主动脉夹层起病凶险,进展迅速,早期诊断、根据母婴情况选择合适的治疗方法是挽救患者及胎儿生命的关键。     

CT血管成像在急诊胸主动脉夹层中的应用

目的：探讨多层螺旋CT血管成像（CT angiography, CTA）在急诊胸主动脉夹层（thoracic aortic dissection, TAD）中的应用价值。方法回顾分析42例手术确诊为TAD患者的影像学资料,其中22例患者经CTA检查,18例经超声多普勒检查,27例经数字减影血管造影（digital subtract angiography, DSA）检查,研究3种检查方法在TAD患者诊断中的正确诊断率及耗时。结果22例患者经CTA检查全部诊断为主动脉夹层,正确诊断率为100%,DeBakey分型准确,平均耗时为25 min;27例患者经DSA检查全部诊断为主动脉夹层,正确诊断率为100%,DeBakeyⅠ型误诊为Ⅱ型者1例,平均耗时38 min;经胸超声检查有11例诊断为主动脉夹层,正确诊断率为61.1%,经食道超声检查有16例诊断为主动脉夹层,正确诊断率为88.9%,两者结合可全部确诊18例患者为主动脉夹层,正确诊断率为100%,DeBakey分型准确,平均耗时24 min。结论CTA具有诊断正确率高、分型准确、耗时少等特点,是TAD急诊诊断方法的理想选择。     

主动脉夹层72例分析

目的探讨主动脉夹层的临床特点及诊治方法。方法对72例主动脉夹层患者临床特点、诊断方法、治疗及并发症的发生情况进行回顾性分析。结果 72例患者中63例（87.5%）以剧烈胸背痛或腰腹痛为首发症状,发病时伴有高血压（70.8%,51/72）、脉搏短缺（8.3%,6/72）、血管杂音（9.7%,7/72）、主动脉瓣区杂音（11.1%,8/72）为主动脉夹层患者最常见临床特点;主动脉全层CTA为主动脉夹层患者首选且有确诊意义的检查。主动脉夹层分型以De BakeyⅢ型为最常见（90.3%,65/72）,镇痛、β受体阻滞剂＋降压治疗、主动脉腔内修复术为其主要治疗。48例行主动脉夹层腔内修复术,9例转外科行手术治疗,15例未行手术（假腔血栓形成未见明显破口3例,肠系膜上动脉、双肾动脉起自假腔不能手术1例,因破口位置复杂、外科风险高而未行手术2例,消化道出血并脑缺血、多脏器功能衰竭未手术3例,急性期主动脉破裂死亡2例,因病情严重自动出院4例）。好转出院61例,院内死亡7例,自动出院4例（未随访）。结论主动脉夹层患者多患有高血压病,症状以胸痛为主,主动脉CTA是首要检查方法,药物治疗是基础,腔内修复术是首选的治疗方法。     

非功能性甲状旁腺癌一例报告

PC是一种罕见的恶性肿瘤，占所有恶性肿瘤的0.005%，其中90%以上是高功能性的，分泌PTH，这类患者表现出高钙血症的症状。而不到10%的PC是非功能性的，不分泌PTH。因为非功能性的甲状旁腺癌（nonfunctional parathyroid carcinoma，NFPC）没有高钙血症的症状，通常发现的更晚，常表现为喉返神经侵犯引起的肿块效应症状，如声音嘶哑。     

Duchenne肌营养不良的临床表现及诊断治疗进展

Duchenne肌营养不良（Duchenne muscular dystrophy, DMD）是由编码抗肌萎缩蛋白（Dystrophy）基因突变所致的X 连锁隐性遗传病,主要表现为进行性对称性骨骼肌无力和萎缩,儿童DMD起病隐匿,临床表现多样,存在运动症状和非运动性症状,容易误诊为其他疾病。在过去的20年中,针对DMD发病机制的基因治疗取得了巨大的进展,其中外显子跳跃、无义突变通读、腺相关病毒介导的基因替代以及CRISPR 基因编辑技术等新型方法是目前治疗研究的热点,正在成为治疗 DMD 的最佳手段。     

Anaphylactic risk related to omalizumab,benralizumab, reslizumab,mepolizumab, and dupilumab

BackgroundMonoclonal antibodies (mAbs) are novel, effective therapeutics for the treatment of inadequately controlled severe asthma. Knowledge of the anaphylaxis risks related to different mAbs is essential for their appropriate and safe administration. This study aimed to evaluate the associations between different mAbs and anaphylactic reactions by applying statistical approaches to pharmacovigilance data.MethodsThis was a retrospective study using data from the US Food and Drug Administration Adverse Event Reporting System database from January 2004 to September 2020. A total of 2006 reports of anaphylaxis related to benralizumab, dupilumab, mepolizumab, omalizumab, and reslizumab were obtained through data mining. The clinical characteristics of the cases were analyzed, and the risk signals of anaphylactic reactions and corresponding outcomes were investigated in the five mAbs.ResultsThe patients were mainly young and middle‐aged adults, with markedly more women than men. Omalizumab, benralizumab, reslizumab, and mepolizumab showed positive signals for anaphylaxis, while only dupilumab showed a negative signal. The risk of initial or prolonged hospitalization due to anaphylaxis was significantly higher in the benralizumab group than in the omalizumab group (42.86% vs. 28.92%, p = 0.024). Further, when anaphylaxis to omalizumab occurred, patients with asthma were more likely to have life‐threatening outcomes than those with chronic urticaria (18.0% vs. 12.9%, p = 0.022).ConclusionIn the current real‐world study, the positive anaphylaxis signals related to omalizumab, benralizumab, reslizumab, and mepolizumab suggested the need for the close monitoring of patients after drug use, and dupilumab showed a negative signal for anaphylaxis.     

关节镜下肘关节松解术后加压冷敷的效果研究

目的 探讨关节镜下肘关节松解术后加压冷敷缓解疼痛和肿胀的治疗效果。方法 将2011年9月—2014年6月期间在我院收治的肘关节镜下行神经松解术的40例患者,随机分为两组,实验组和对照组,每组分别为20例患者。其中,对实验组的20例患者在术后第二天开始采取对患肢进行冰袋加压冷敷;对对照组的20例患者在术后进行常规的手外科护理。将两组患者术后疼痛及肿胀消退情况进行统计分析。结果 通过不同的护理,对比分析两组患者,实验组患者术后使用加压冷敷与对照组只进行常规的手外科护理相比显著差异,具有统计学意义(P＜0.05)结论 肘关节镜下关节松解术后及时对患肢进行加压冷敷可以有效地减轻患肢疼痛及肿胀,值得在临床上推广。     

GVHD after transfusion of stored RBC concentrates in a solution of mannitol, adenine, phosphate, citrate, glucose, and NaCl following trauma

BACKGROUND: It has not previously been reported that WBC-reduced RBC preparations can cause transfusion-associated GVHD, even in an immunocompetent individual. CASE REPORT: A 74-year-old man suffered a hemorrhage from the mesentery of the transverse colon after a traffic accident. During surgery, he received 10 units of RBCs from 10 donors in a solution containing mannitol, adenine, phosphate, citrate, glucose and NaCl (MAP). MAP RBCs had been stored for 7 to 8 days before use. On the 27th day after surgery, an erythematous, pruritic rash appeared over the face, neck, and trunk, which was associated with low-grade fever and pancytopenia. Transfusion-associated GVHD was strongly suspected and was confirmed by skin biopsy. To determine the origin of lymphocytes causing GVHD, several microsatellite loci were amplified from DNA of the patient's nails and blood and from blood samples of all 10 RBC donors by using PCR. Amplified alleles derived from the patient's blood were identical to those from one of the 10 samples. CONCLUSION: These findings indicate that transfusions of MAP-RBCs can cause transfusion-associated GVHD in an elderly but immunocompetent host.     

Management of Type 2 Diabetes: Current Strategies,Unfocussed Aspects,Challenges, and Alternatives

Type 2 diabetes mellitus (T2DM) accounts for >90% of the cases of diabetes in adults. Resistance to insulin action is the major cause that leads to chronic hyperglycemia in diabetic patients. T2DM is the consequence of activation of multiple pathways and factors involved in insulin resistance and β-cell dysfunction. Also, the etiology of T2DM involves the complex interplay between genetics and environmental factors. This interplay can be governed efficiently by lifestyle modifications to achieve better management of diabetes. The present review aims at discussing the major factors involved in the development of T2DM that remain unfocussed during the anti-diabetic therapy. The review also focuses on lifestyle modifications that are warranted for the successful management of T2DM. In addition, it attempts to explain flaws in current strategies to combat diabetes. The employability of phytoconstituents as multitargeting molecules and their potential use as effective therapeutic adjuvants to first line hypoglycemic agents to prevent side effects caused by the synthetic drugs are also discussed.     

微信公众号在结肠镜诊疗中肠道准备的应用

研究目的 探讨基于微信公众号“结肠镜检查准备须知”实时提醒对结肠镜诊疗患者的肠道准备执行的依从性,肠道准备清洁度及患者和医生满意度的影响。研究方法 将244例患者随机分为实验组122例,对照组122例。两组患者均在预约时给予口头及书面的肠道准备宣教。实验组在口头和书面指导的基础上使用公众号“结肠镜检查准备须知”,分别对饮食、服药、诊疗前后注意事项进行微信实时推送提醒和强化指导;对照组使用常规方法进行指导。在结肠镜诊疗前通过自行设计的问卷调查评估两组患者肠道准备的知晓度和执行度,使用Boston量表评价肠道清洁程度,同时评价患者和医生的满意度。研究结果 实验组肠道准备知晓度和执行度明显高于对照组（P<0.05）,实验组患者肠道准备清洁度优于对照组（P<0.05）,实验组患者和医生的满意度高于对照组（P<0.05）。结论 基于微信的“结肠镜检查准备须知”的运用对增强患者肠道准备依从性,提高肠道准备质量具有显著效果,提升了患者和医生的满意度。     

Meta-analysis: Methods, strengths, weaknesses, and political uses

The general methodology, strengths and weaknesses, and political uses of meta-analysis are examined. As a systematic study of all studies that have been conducted to answer a specific question or hypothesis, meta-analysis is strong in revealing structural flaws and sources of bias in primary research and in posing promising research questions for future study. It cannot exceed, however, the limits of what is reported by primary researchers. Meta-analysis is particularly challenged to quantify the size of a common effect of treatment across reported trials because of (1) the clinical diversity of the trials and (2) the myriad of potential differences among patients with varying characteristics within the trials. Without access to the original data of reported trials, meta-analysis cannot overcome the bias of underpowered trials toward overstatement of the size of main treatment effects, nor the tendency for such trials to falsely conclude there were no statistically significant adverse events. Although severely compromised by ghost-written or honorary-authored reports of primary research, meta-analysis can make use of its methods to focus on the conflicts of interest and likely sources of bias of such research and make known what precautions should be taken by would-be consumers. Examples show how meta-analysis has clarified thinking about the off-label use of selective serotonin reuptake inhibitors for treating child and adolescent depression, use of low-tidal volume respirator assistance for acute lung injury and acute respiratory distress syndrome patients, and the long-term use of COX-2 inhibitors for relieving arthritic pain. Recommendations are made for Congressional action.     

支气管动脉灌注化疗联合放射免疫治疗中晚期肺癌的护理

目的 探讨支气管动脉灌注化疗（bronchial artery infusion, BAI）联合放射免疫治疗（radioimmunotherapy, RIT）中晚期肺癌的护理方法。方法 对32例中晚期肺癌患者行BAI联合RIT治疗进行围手术期护理,随访4-26月。结果 32例患者均顺利完成1-4次BAI治疗及1次RIT治疗,无技术性差错及护理意外发生。结论 恰当的围手术期护理,可防止BAI联合RIT治疗肺癌护理差错的发生,避免放射性损伤。